Patricia Mechael, executive director, mHealth Alliance

Will Palley, 29 January 2014

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We’re definitely seeing a massive upsurge in the use of mobile technologies within the health sector,

In emerging markets, the mobile device represents a gateway to opportunity, helping people at the bottom of the pyramid gain access to financial services, education and more, as we explain in our 10 Trends for 2014 and Beyond report. One of the most promising areas is mobile health, or mHealth, with mobile devices delivering health information and services to people who otherwise have limited access. While researching this topic, we spoke to Patricia Mechael, executive director of the mHealth Alliance, which is hosted by the United Nations Foundation. She discussed the rapid evolution of mHealth, some of the benefits it brings and how it might evolve, noting that it will soon become “part and parcel of the way that health services are delivered and accessed.”

It seems like mHealth is a concept that’s come a long way very quickly?

It’s been an incredible journey so far. I don’t think anybody would have anticipated that mHealth would have become a field five or 10 years ago. Now it’s part and parcel of every global health strategy, country priorities and community-based interventions. We’re definitely seeing a massive upsurge in the use of mobile technologies within the health sector, both informally and formally.

Now more and more what we’re starting to see is a real galvanization within the field and most stakeholders moving forward and pushing towards the same set of goals, which is quite exciting. And a lot of this is coming together through the leadership at the country level. So you have governments standing up and setting the tone for what they see as a mobile-enabled health system, which then creates an enabling environment for industry to invest or donors to align, and then for academic institutions to evaluate them.

What are the broad objectives of mHealth?

We’re seeing the push toward improved health outcomes and creating efficiency within the health system. So on the outcome side, it can range on anything from, Can we immunize every child in a country? and Can we register every child and then track them to make sure they’re being immunized for all their childhood immunizations? Can we create a platform where citizens can hold the government and the health system accountable to their needs? Can we empower people in a very different way than we could have before?

What we’re starting to see is more of a values-based approach to mHealth, as well as a shift out of the technology into the metrics of the health system used to assess whether an intervention or program is having a positive impact.

Can you talk a bit more about how mHealth can be empowering for people?

What mobile is enabling is a much more personalized approach to health. So that, for those who are healthy, they can personalize their own wellness rituals or engagement or strategies, etc. For those who have fallen ill, they can leverage the mobile as part of the diagnostic and treatment process.

For those who are chronically ill, the mobile can provide remote monitoring so they can both respond to their own health in real time but then also receive alerts, and their providers can also monitor their progress and receive alerts when something goes wrong. So there’s a lot of ways at a very individual level we can start to move towards what one of my colleagues refers to as citizen-centered health care.

In developing countries, we’re seeing in particular [projects] around maternal and child health, a lot of pregnancy-related and child health-related tools that provide information to households. Programs like the Mobile Alliance for Maternal Action, or MAMA, are mobile messaging for pregnant women and families. You also see an uptake in the use of mobile technologies to do remote monitoring and keep older people in their homes for longer or engaged in social networks and supportive networks—that sort of thing.

How are mobile devices helping to diagnose health conditions?

Mobile imaging is really interesting. Dermatology is one of the first areas where mobile telemedicine was used. So you could have a community health worker or a nurse using the mobile device to capture an image, send it to a higher-level health practitioner or specialist, and then receive feedback and guidance on what they should be doing. We’re also now advancing toward laboratory diagnostic capabilities, through microscopy integration with mobile phone technology.

Many mHealth initiatives are either small local projects or nonprofits. What is the key to sustainable, profitable programs?

There are a few approaches that are starting to emerge. One is the freemium model, where you provide a basic service and a basic application for free. Anything above that—any customization, any tailoring for a specific implementation—then it becomes where you generate your revenue. So that’s more on the product side.

A lot of times when you say mobile health, everybody thinks the telecommunications [companies] are the ones that are going to make money off this. That’s actually not true, because the incremental cost they’ve received so far is not significant and the volume has not reached the scale to make it worth their while. So far, they can create client loyalty, they can create revenue-sharing models. They can deliver a broad range of services at scale, but these services, while beneficial for health, may never affect the bottom line of the telcos.

The two major stakeholders that are most incentivized to pay for mHealth are governments, on the public health side, and pharmaceutical and insurance companies, on the private health care side. There are revenue models that are starting to emerge within the pharma industry. Some early experiments with revenue-sharing between service providers and telcos, such as Switchboard, have shown some early promising results that benefit both the health sector and the telcos.

The model that has proven most successful, which is great and to me really where the future lies, are things like the WellDoc approach, which is a diabetes-monitoring service here in the United States. Very early on, they invested in randomized control trials as well as cost-benefit research that showed that investments in WellDoc improve diabetes health outcomes tremendously and save the health system a significant amount of money. So what we have now are Medicare, Medicaid, insurance companies scrambling to provide WellDoc services to their clients.

We also see [projects] around counterfeit drug systems and platforms. Counterfeit drugs in most countries have two major issues. One, they can cause harm to an individual. Second, by taking a counterfeit, you’re not taking the actual medication you should be on, which basically means that whatever condition you have is persisting. The harm that counterfeit drugs have caused in health care systems is tremendous. One of the countries that has been highly affected by this is Nigeria. The way that anti-counterfeit-drug tools work is that special barcodes are issued from the manufacturers. By creating a toll free phone line, you can have people enter in the code off their medications into a database that tells them whether the drug they have in their hand is counterfeit or real.

It’s in the interest of the pharmaceutical companies to invest in this. It’s also in the interest of the drug administration in countries where this is a problem to invest in this.

How do you see mHealth evolving in the future?

There are two things that are going to happen. We’re going to get to a place where mobile technologies are just going to be part and parcel of the way that health services are delivered and accessed, and so we won’t even be talking about mobile health in a few years from now—we won’t need the term. It will just be how things get done and how people interact with the health system. On the innovation side, we’re going to see a lot more on the sensor-based-technology front.

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